Stanley Feld M.D.,FACP,MACE
The Obama administration refuses to believe that physicians are not interested in seeing Medicaid patients. The Obama administration must think that by increasing Medicaid enrollment the number of physicians willing to see these patients will increase. I believe the Obama administration is wrong.
A survey called the Health Tracking Study Physician Survey, sponsored by the Center for Studying Health System Change, polled more than 4,700 physicians around the country in 2008.
The survey covered many private practice issues. One question surveyed was about new patients these physicians would likely accept.
There is an additional cohort of doctors who only accept “some” (i.e. reject most) new Medicaid patients.
These numbers might surprise some but they reflect reality.
The physicians who accept “all” or “most” Medicaid patients are a concentrated minority.
This means that if you have Medicaid insurance coverage it will be very hard to find a physician who will see you.
The administration refuses to believe that the 32 million new Medicaid patients will have a difficult time finding a physician.
Most other observers accept the fact that Medicaid beneficiaries have a tough time finding physicians. The main reason is due to the fact that Medicaid deeply underpays physicians and hospitals for their services.
There is also resistance by progressive thinkers to believe that Medicaid coverage has poor performance outcomes.
In reality Medicaid coverage is bad insurance coverage.
Medicaid Is Worse Than No Coverage at All!
“New research shows that patients on this government plan fare poorly. The question is why does the President Obama want to shove one in four Americans into it?"
Dr. Gottlieb’s question is a very good question.
“We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher.”
The was no difference in “clinical outcomes.” However, as I explained on many occasions, in the past there are large defects in measuring clinical outcomes.In additional, the findings in clinical outcome studies are often misinterpreted.
“Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.”
The results of screening for depression in the Oregon Experiment are not statistically significant. In order to be statistically significant a p value has to be less that .05.
Ezra Klein of the Washington Post found the words to publish the results as very positive for Medicaid coverage using the Oregon Experiment as proof. The article was entitled “Here’s what the Oregon Medicaid study really said”
Since the media is the message Ezra Klein used the media to get his biased message out even if the message is wrong.
He might be right that Medicaid coverage is important but the Oregon Experiment did not prove it.
The real problem with the Oregon Experiment is that the design of the study is defective. If a study’s design is wrong the conclusions are wrong on both sides of the argument.
There are real structural problems with Medicaid coverage in its present form. Its reimbursement method is also wrong. The only way to provide quality affordable care to lower income families is to fix Medicaid’s structural defects.
To force 32 million people into a defective system is going to lead to disastrous fiscal and medical care consequences.
I have to think the Obama administration does not care about the results or the administration is blinded by its own ideology.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Please have a friend subscribe